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Microneedling involves the use of tiny needles to make microscopic punctures in the skin. A Post reporter recounts her experience of it in Hong Kong. Photo: Shutterstock

Why microneedling can go wrong for those with darker skin tones, leaving them at greater risk of post-inflammatory hyperpigmentation

  • When Sarah Vega tried microneedling in the US, it left her with clearer skin. When she tried it in Hong Kong, she suffered post-inflammatory hyperpigmentation
  • Darker skin is not meant to have as deep a treatment as paler skin, say experts. Some spas may not know that different skin colours need handling differently

I struggled with acne when I was growing up. I lived in the United States, in the South, and was an avid swimmer. The sun, chlorine and hormones took a toll on my skin and I had scars from picking at my imperfections.

As I got older, my acne mellowed – but the scars persisted. In February 2021, my aesthetician, a skincare specialist, suggested I try out microneedling, which is a minimally invasive procedure that involves the use of tiny needles to make microscopic punctures in the skin.

According to Dr Mamina Turegano, an American dermatologist, “all skin types can definitely benefit from microneedling”.

“The goal is to help with just remodelling collagen,” she says.

Vega before she undertook microneedling to treat her acne scars.
Sarah Vega after a microneedling session in the US.
Collagen, the elastic fibres that make the skin look tight and youthful, decreases as we age. New collagen can be produced when the skin repairs itself after this procedure.

I was willing to give it a try, and had wonderful results. I had a total of five microneedling sessions, four with an aesthetician and the fifth with a nurse while travelling, and the procedure did not hurt.

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I had no adverse side effects and I noticed that my skin was much firmer. My acne scarring was minimised, my skin was clearer and I was more confident in my appearance to the point that I wore little to no make-up.

I was advised to only do microneedling three to five times every year.

In September 2021, I moved to Hong Kong and one of the first things I did was find a place to get facials. Nothing fancy, just a monthly cleansing facial to maintain healthy skin.

Mamina Turegano is an American dermatologist.

The spa I found offered microneedling and I decided to start another round of it.

Unfortunately, I did not have the same experience as I had before.

The process began the same way it usually does: a cleanse, about 30 minutes of numbing, wipe it off, and then away we go. At the Hong Kong spa, the pressure felt a bit more intense than I had remembered, but because of the numbing, it was not exactly painful.

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When my session was over, I noticed that my face was significantly redder than it had ever been before. I hoped it would pass easily.

It did not.

Back in the US, my downtime was maybe one or two days. This time, I could not leave my house for over a week – the redness and discomfort developed into something I came to know as post-inflammatory hyperpigmentation (PIH).
Sarah Vega’s face eight days after her first Hong Kong microneedling experience. Some redness and inflammation is normal but is supposed to subside within 24-48 hours. Photo: Sarah Vega

This can occur when the skin becomes inflamed, causing it to overproduce melanin – resulting in darker spots. In my case, there were sections of my face that were noticeably darker.

I did not know why this was happening. I followed the post-treatment care: no sun, no gym, no retinols, no painkillers, and stayed hydrated.

My previous experiences had, at worst, felt like a light sunburn. This time, I felt like I had voluntarily scraped off a layer of my face and was sporting what looked like half a moustache.

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According to Turegano, “the darker your skin, the less you can do”.

Darker skin is not meant to have as deep a treatment as whiter and paler skins because it can trigger PIH, causing a darkening effect in the process of healing. “I’ll do two millimetres in my lighter skin tone patients,” says Turegano. “I certainly don’t think I’ll go higher than maybe 1.5 [millimetres] in darker skin tone patients.”

While scouring through beauty blogs, YouTube videos and whatever I could get my hands on to rectify the pigmentation problem, I kept coming across one recurring comment: a person’s skin colour and the depth of the needle can cause adverse reactions by triggering a reaction of hyperpigmentation.

When skin becomes inflamed, it can overproduce melanin – resulting in darker spots. Photo: Getty Images

Dr Melanie Lambrechts, a South African doctor and aesthetic practitioner, told the Post much the same.

“It’s actually incredible that most treatments – from microneedling to laser to peels – you can do almost freely on lighter skins,” she said.

“The minute it hits what we call skin type three, the risk of pigmentation shoots up,” says Lambrechts, referring to a scientific skin type classification called the Fitzpatrick scale. Skin tones are classified from one to six based on how susceptible your skin is to the sun.

“A skin type one to six is good with microneedling, but the actual treatment itself will be different in a skin type one versus a six.”

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When it comes to microneedling, deeper is not necessarily better. When there is more trauma, there is more inflammation, and with more inflammation comes hyperpigmentation in darker skin types.

Online, it kept coming up that people of colour should seek out professionals who have experience treating coloured skin, as not all skin colours can handle the same treatments.

Microneedling does not count as a medical treatment, so if your practitioner does not have experience with multiple skin types they may not even know that darker skin could have this negative reaction, which is what happened in Hong Kong.

The Fitzpatrick Scale is a scientific skin type classification.

The United States Federal Drug Administration (FDA) says microneedling may not be suitable for you if you “have (a) darker skin type, as there is a risk of darkening”.

Most beauty treatments tend to be tested first on lighter skin. The FDA website goes on to add that “some of the devices authorised for marketing by the FDA were not studied in subjects with darker skin types”.

Turegano says: “When it comes to procedures, especially with darker skin tones, I am way more cautious with the level or strength of ingredients. I tend to go slow with my darker skin tone patients just because there is an increased risk for hyperpigmentation.”